Pharmacy Clinic
Hemorrhoid
Hemorrhoids management

Management
Symptomatic treatment of hemorrhoids can provide relief from discomfort, but if present, the
underlying cause of constipation must also be addressed. The pharmacist is in a good position to
offer dietary advice in addition to treatment, to prevent recurrence of symptoms in the future.

Local anaesthetics (e.g. benzocainc, lignocainc)
These can help to reduce the pain and itching associated with haemorrhoids. There is a possibility
that local anaesthetics may cause sensitization, and their use is best limited to a maximum of 2
weeks.

Skin protectors
Many antihaemorrhoidal products are bland, soothing preparations, and contain skin protectors, for
example, zinc oxide and kaolin. These products have emollient and protective properties. Protection
of the perianal skin is important, because irritation and itching due to the presence of faecal matter
can cause symptoms. Protecting agents form a barrier on the skin surface, helping to prevent
irritation and loss of moisture from the skin.

Astringents
Astringents such as zinc oxide, hamamelis (witch hazel) and bismuth salts are included in products
on the theoretical basis that they will cause precipitation of proteins when applied to mucous
mem¬branes or skin which is broken or damaged. A protective layer is then thought to be formed,
helping to relieve irritation and in¬flammation. Some astringents also have a protective and mild
antiseptic action, for example bismuth.

Antiseptics
These are among the ingredients of many antihaemorrhoidal products, including the medicated toilet
tissues. They do not have a specific action in the treatment of haemorrhoids. Resorcinol has
antiseptic, antipruritic and exfoliative properties. The ex¬foliative action is thought to be useful by
removing the top layer of skin cells and aiding penetration of medicaments into the skin. Resorcinol
can be absorbed systemically via broken skin if there is prolonged use, and its antithyroid action can
lead to the development of myxoedema (hypothyroidism).

Counter-irritants
Counter-irritants such as menthol are sometimes included in antihaemorrhoidal products on the basis
that their stimulation of nerve endings gives a sensation of cooling and tingling, which distracts from
the sensation of pain. Menthol and phenol also have antipruritic actions.

Shark liver oil/live yeast
These agents are said to promote healing and tissue repair, but there is no scientific evidence to
support such claims.

Laxatives
The short-term use of a laxative to relieve constipation might be considered. One or two days’ supply
of a stimulant laxative (e.g.

senna) should help to deal with the immediate problem, while dietary fibre and fluids are being
increased. For patients who cannot or choose not to adapt their diet, bulk laxatives may be used long
term.

Practical points

Self-diagnosis
Patients may say that they have piles, or think they have piles, but careful questioning by the
pharmacist is needed to check whether this self-diagnosis is correct. If there is any doubt, referral is
the best course of action.

Hygiene
The itching of haemorrhoids can often be improved by good anal hygiene, since the presence of small
amounts of faecal matter can cause itching to occur. The perianal area should be washed with warm
water as frequently as is practicable, ideally, after each bowel movement. Soap will tend to dry the
skin and could make itching worse, but a mild soap could be tried if the patient wished to do so.
Moist toilet tissues are available and these can be very useful where washing is not practical, e.g. at
work during the daytime, and some patients prefer them. These tissues are better used with a
patting rather than a rubbing motion, which might aggravate symptoms. Many people with
haemorrhoids find that a warm bath soothes their discomfort.
An increased intake of dietary fibre will increase bowel output, so that patients can be well advised
to take care in wiping the perianal area, and to use soft toilet paper to avoid soreness after wiping.

How to use over-the-counter products
Ointments and creams can be used for internal and external haemorrhoids, and should be applied in
the morning and at night, and after each bowel movement. An applicator is included in packs of
ointment and creams, and patients should be advised to take care in its use, to avoid any further
damage to the perianal skin.

Suppositories can be recommended for internal haemorrhoids. After removing the foil or plastic
packaging (patients have been known to try and insert them with the packaging left on), a
suppository should be inserted night, morning and after bowel move¬ments. Insertion is easier if the
patient is lying down or crouching.


Classification of Hemorrhoid

Hemorrhoid Management

Natural Remedies for Hemorrhoid

Tips for treating hemorrhoid



For detailed information,
Free Download; Hemorrhoid slides